ATLANTA -- During Georgia's hepatitis A outbreak, a single Atlanta Farmers' Market distributor provided green onions - the food believed to be the source of the outbreak - from California suppliers to Norcross, Macon and Centerville restaurants where multiple people caught the liver infection, according to a preliminary Georgia Division of Public Health report obtained by The Associated Press.
The report also identified for the first time that hepatitis A strains in the multi-state outbreak were the same for two states, Georgia and North Carolina, and that the virus strain responsible for those outbreaks likely came from the same source.
Between Sept. 1 and Oct. 15, Georgia had 259 hepatitis A cases, an amount that far exceeded the 10 cases per week that state health officials typically expected to see. There were no Georgia deaths and the cases mainly clustered around metro Atlanta and Macon.
"We were very lucky in Georgia that people that got sick have gotten better or are continuing to recover," said Richard Quartarone, health division spokesman. "We were able to act very quickly on it."
At the same time, hepatitis A cases exploded among Georgia's neighbors. There were 81 cases of the infection among diners at a Knoxville O'Charley's restaurant. About 16 people also were infected in Asheville, N.C., the site of a third hepatitis A restaurant outbreak. More than 550 people were infected - including three deaths - in a recent outbreak in October and this month involving a Monaca, Pa., restaurant.
Hepatitis A is transmitted from person to person by putting something in the mouth that has been contaminated with the feces of a person with hepatitis A, according to the Centers for Disease Control and Prevention.
The Knoxville hepatitis A strain had an RNA sequence that health officials called type B but both the Georgia and North Carolina strains had a type A RNA sequence, the report said.
The green onions in the Tennessee and Georgia outbreaks likely came from Mexico, the CDC reported Friday, adding that the vegetables could have been contaminated by infected workers harvesting the green onions or through contact with contaminated water during irrigation or processing.
Although the Georgia outbreak involved multiple restaurants, the report said that three restaurants - in Norcross, Centerville and Macon - were named by four or more people as places where they dined in the weeks before they became infected.
Health officials declined to identify the restaurant's names but Nashville, Tenn.-based O'Charley's acknowledged in a Securities and Exchange Commission filing on Friday that at least 10 people got the virus after eating at the chain's restaurants in Centerville and in Macon.
In the health division's report, officials surveyed ill and healthy diners at the Norcross restaurant and found that those who ate a food with green onions had a 37 time greater chance of becoming ill than those who didn't.
The Georgia cases spanned six other states - Illinois, Maryland, North Carolina, Wisconsin, Washington and Florida - as infected diners from those areas all came to Georgia for vacation or for conferences, the report said.
On the Net:
Georgia hepatitis A info: http://www.ph.dhr.state.ga.us/healthtopics/hepatitisa.shtml